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Hydrocortisone sodium succinate parenteral


Injections containing hydrocortisone.

Drugs List

  • hydrocortisone (as sodium succinate) 100mg powder for solution for injection vial
  • SOLU-CORTEF 100mg powder for solution for injection vial
  • Therapeutic Indications


    Adrenal insufficiency - cortical
    Inflammatory or allergic conditions
    Shock - adrenal crisis
    Status asthmaticus

    Anti-inflammatory agent is indicated for any condition in which rapid and intense corticosteroid effect is required such as:

    Endocrine disorders
    Primary and secondary adrenal insufficiency

    Collagen diseases
    Systemic lupus erythematosus

    Dermatological diseases
    Severe erythema multiforme (Stevens-Johnson syndrome)

    Allergic states
    Bronchial asthma
    Anaphylaxis (as adjunctive therapy to emergency treatment with

    Gastro-intestinal diseases
    Ulcerative colitis
    Crohn's disease

    Respiratory diseases
    Aspiration of gastric contents

    Medical emergencies
    Shock - adrenal crisis

    Unlicensed Uses

    Neonatal hypotension resistant to other treatment

    Neonatal hypotension resistant to other treatment


    The preferred route for emergency use is by intravenous injection.
    Following initial emergency use consider using a longer acting injectable or oral preparation.

    Frequent patient review is required to titrate dose against disease activity.

    In general, high dose corticosteroid therapy should be continued only until the patient's condition has stabilised, usually not beyond 48 to 72 hours.


    Usual dosage range: 100mg to 500mg by intravenous injection over 1 to 10 minutes.
    Doses may be repeated at 2, 4 and 6 hours as indicated by response and clinical condition.

    The following alternative dosing schedules may be suitable:

    Acute hypersensitivity reactions (adjunct to adrenaline)
    100mg to 300mg by intravenous injection.

    Adrenocortical insufficiency
    100mg to 500mg by intramuscular injection, slow intravenous injection or infusion three or four times a day, or as required.

    Severe inflammatory bowel disease
    100mg to 500mg by slow intravenous injection or infusion three or four times a day, or as required.

    Adrenocortical insufficiency resulting from septic shock
    50mg by intravenous injection every 6 hours, given in combination with fludrocortisone.

    Corticosteroid replacement, in minor surgical patients previously stabilised on the equivalent of greater than 10mg prednisolone daily within the last three months
    25mg to 50mg by intravenous injection or infusion at the induction of surgery. Give the patient's usual corticosteroid dose after surgery.

    Corticosteroid replacement, in moderate or major surgical patients previously stabilised on the equivalent of greater than 10mg prednisolone daily within the last three months
    Initial dose: 25mg to 50mg by intravenous injection or infusion at the induction of surgery, after the patient's usual corticosteroid dose on the morning of surgery.
    Maintenance dose: 25mg to 50mg by intravenous injection or infusion three times a day for 24 hours following moderate surgery and for 48 to 72 hours following major surgery.

    Severe acute asthma
    100mg by intravenous injection every 6 hours until conversion to oral prednisolone possible (in combination with other treatments).

    Thyrotoxic crisis (thyroid storm)
    100mg by intravenous injection every 6 hours.


    Dosage may be reduced in children but is guided more by condition severity than by age or weight.
    The dose should not be less than 25mg daily.

    The following alternative dosing schedules may be suitable:

    Acute adrenocortical insufficiency (Addisonian crisis)
    Children aged 12 to 18 years
    100mg intravenously every 6 to 8 hours.
    Children aged 1 month to 12 years
    Initial dose: 2mg/kg to 4mg/kg as a slow intravenous injection or infusion
    Maintenance dose: 2mg/kg to 4mg/kg every 6 hours. Titrate to response. Reduce over four to five days to oral maintenance dose when patient is stable.

    Remission of inflammatory bowel disease
    Children aged 2 to 18 years: 2.5mg/kg (maximum 100mg per dose) by intravenous injection every 6 hours OR 10mg/kg daily (maximum 400mg daily) by continuous intravenous infusion.

    Acute hypersensitivity reactions; Angioedema
    Children aged 12 to 18 years: 200mg intramuscularly or intravenously three times daily. Titrate according to response.
    Children aged 6 to 12 years: 100mg intramuscularly or intravenously three times daily. Titrate according to response.
    Children aged 6 months to 6 years: 50mg intramuscularly or intravenously three times daily. Titrate according to response.
    Children aged 1 to 6 months: 25mg intramuscularly or intravenously three times daily. Titrate according to response.

    Severe acute asthma
    4mg/kg intravenously (maximum 100mg per dose) every 6 hours. This equates approximately to:
    Children aged 5 to 18 years
    100mg every 6 hours.
    Children aged 2 to 5 years
    50mg every 6 hours.
    Children aged 1 month to 2 years
    25mg every 6 hours.

    Hypotension resistant to inotropic treatment and volume replacement (limited evidence) (unlicensed)
    1mg/kg intravenously (maximum 100mg) every 6 hours.


    Acute adrenocortical insufficiency (Addisonian crisis)
    Initial dose: 10mg as slow intravenous injection.
    Maintenance dose: 100mg/metre squared daily as a continuous infusion or in divided doses every 6 to 8 hours. Titrate according to response. Reduce over four to five days to oral maintenance dose when the patient is stable.

    Hypotension resistant to inotropic treatment and volume replacement (limited evidence) (unlicensed)
    Initial dose: 2.5mg/kg intravenously, repeated if necessary after 4 hours.
    Maintenance dose: 2.5mg/kg every 6 hours for 48 hours or until blood pressure recovers, then dose reduced gradually over a period of at least 48 hours.

    Additional Dosage Information

    Although uncommon, peptic ulceration can occur with high dose short term corticosteroids and acid suppression prophylaxis may be considered.

    Patients subjected to severe stress following corticosteroid therapy should be observed closely for signs and symptoms of adrenocortical insufficiency.

    Hydrocortisone withdrawal
    Gradual withdrawal of therapy will be required in patients who have received more than 30mg hydrocortisone (approximate physiological dose) for greater than three weeks. Determine how dose reduction is to be carried out based on the likelihood of disease relapse on withdrawal and likelihood of hypothalamic-pituitary-adrenal (HPA) suppression. If disease is unlikely to relapse but hypothalamic-pituitary adrenal suppression is uncertain, a rapid reduction of dosage to 30mg daily may be effected, then dose reduction should be slowed down to allow the HPA-axis to recover.

    Abrupt withdrawal of systemic hydrocortisone treatment which has continued up to 3 weeks is appropriate if it is considered that the disease is unlikely to relapse. Abrupt withdrawal of doses of up to 160mg daily of hydrocortisone for three weeks is unlikely to lead to clinically relevant HPA-axis suppression in the majority of patients.

    In the following patient groups gradual withdrawal of systemic corticosteroid therapy should be considered even after courses lasting three weeks or less:

    a) Patients who have had repeated courses of systemic corticosteroids, especially if taken for greater than three weeks.
    b) When a short course has been prescribed within one year of cessation of long term therapy.
    c) Patients who may have reasons for adrenocortical insufficiency other than exogenous corticosteroid therapy.
    d) Patients receiving doses greater than 160mg daily.
    e) Patients repeatedly taking doses in the evening.


    May be given by intravenous injection, intravenous infusion or intramuscular injection.

    The preferred route for emergency use is by intravenous injection.


    Uncontrolled systemic infection

    Precautions and Warnings

    Children under 18 years
    Family history of diabetes mellitus
    Family history of glaucoma
    Predisposition to thrombophlebitis
    Congestive cardiac failure
    Corneal damage
    Diabetes mellitus
    Epileptic disorder
    Gastrointestinal anastomosis
    Hepatic cirrhosis
    Hepatic impairment
    History of severe affective disorders
    History of steroid myopathy
    History of steroid-induced psychosis
    History of tuberculosis
    Myasthenia gravis
    Ocular herpes simplex infection
    Peptic ulcer
    Recent myocardial infarction
    Renal impairment
    Severe affective disorders
    Thromboembolic disorder
    Ulcerative colitis

    Administration of live vaccines is not recommended
    Consider increased dose during intercurrent illness/trauma/surgery
    Consider reintroducing steroids temporarily during illness/trauma/surgery
    Disease reactivation may occur in patients with latent TB
    Exposure to measles may require prophylaxis with normal immunoglobulin
    May mask symptoms or signs of infections
    Consider prophylactic anti-tuberculosis therapy if appropriate
    Passive immunisation of chicken pox / herpes zoster may be required
    Premature infants: Perform cardiac evaluation and monitoring
    Clinical presentations of infections may be atypical
    Frequent review needed to titrate dose to disease activity
    If visual disturbances occur, perform ophthalmic evaluation
    Monitor regularly the height of children receiving prolonged treatment
    Prolonged or high dose may lead to adrenal suppression
    Psychological changes may occur during initiation & withdrawal of treatment
    Supervise patient closely during drug withdrawal
    Adrenal cortical atrophy may persist for years after stopping drug
    Antibody response to vaccines may be reduced
    Corticosteroids may cause growth retardation in children under 18 years
    May cause activation of latent psychosis
    May cause posterior subcapsular cataracts and glaucoma in long term use
    Oversuppression of immune system may increase susceptibility to infection
    Patient should report worrying psychological changes esp. suicidal thoughts
    Potassium supplements may be required
    Sudden withdrawal may be inadvisable -see product information/SPC
    Maintain treatment at the lowest effective dose
    Advise patient not to take St John's wort concurrently
    Advise patient grapefruit products may increase plasma level
    Dietary salt restriction may be necessary
    Advise patient to avoid exposure to measles
    Advise patient to seek urgent medical attention if exposed to measles
    Advise those on systemic corticosteroids to avoid chickenpox/H zoster
    Ensure patient receives Steroid Treatment/Steroid Emergency Card
    If exposed to chickenpox or Herpes zoster seek urgent medical attention

    In acute, life-threatening situations, administration of dosages exceeding the usual level may be justified. In these circumstances the slower rate of absorption by the intramuscular route should be noted.

    High dose corticosteroids should be avoided in septic shock. However, there is evidence that low doses of hydrocortisone may be of benefit in adrenocortical insufficiency resulting from septic shock.

    Patients (or parents of children) without a definite history of chicken pox should be advised to avoid close personal contact with chicken pox or herpes zoster and seek urgent medical attention if exposed as chicken pox can prove fatal in immunocompromised patients. If exposed while on dexamethasone or within three months of previous use, passive immunisation with varicella/zoster immunoglobulin (VZIG) should be administered within 10 days of the exposure. If chicken pox occurs, treat urgently under specialist care. Do not stop dexamethasone therapy, an upward dosage adjustment may be required.

    Prolonged use of pharmacological doses of corticosteroids can lead to hypothalamic-pituitary-adrenal (HPA suppression). The duration and severity of adrenocortical insufficiency is dependant on dose, frequency, duration of glucocorticoid therapy and time of administration. Acute adrenal insufficiency may be fatal if glucocorticoid treatment is withdrawn too rapidly. A gradual reduction in dosage can help to minimise the effects of drug-induced secondary adrenocortical insufficiency. However, this type of relative insufficiency can persist for many months to years after treatment has been discontinued. Reinstitution of hormone therapy may be required in times of stress during this period.

    Systemic corticosteroids should not be used to treat head injury or stroke because it is unlikely to be of any benefit and may even be harmful. A study has revealed an increased mortality at 2 weeks and 6 months after injury in patients administered with methylprednisolone sodium succinate compared to placebo.

    Reported cases of hypertrophic cardiomyopathy was observed in premature infants after hydrocortisone administration, therefore cardiac function and structure should be monitored.

    Pregnancy and Lactation


    Use hydrocortisone sodium succinate with caution during pregnancy.

    The manufacturer recommends that hydrocortisone sodium succinate should only be used if the benefits to the mother and child outweigh the risks. When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of intrauterine growth retardation. Hypoadrenalism may occur in the neonate following prenatal exposure but usually resolves spontaneously following birth and is rarely clinically important.

    Hydrocortisone readily crosses the placenta. Schaefer (2015) suggests that there is inconclusive evidence that corticosteroids result in an increased incidence of congenital abnormalities however, a possible association with oral clefts cannot be excluded.

    When corticosteroids are essential, patients with normal pregnancies may be treated as though they were in the non-gravid state.


    Use hydrocortisone sodium succinate with caution during breastfeeding.

    The manufacturer recommends that hydrocortisone sodium succinate should only be used during breastfeeding after an assessment of the benefits and risks to the mother and the infant. Infants of mothers taking higher doses may have a degree of adrenal suppression, but the benefits of breastfeeding are likely to outweigh any theoretical risk.

    Corticosteroids are excreted in small amounts in breast milk, and both Schaefer (2015) and Briggs (2015) report that there are no reports to date of the use of hydrocortisone during breastfeeding. Schaefer recommends that prednisolone and methylprednisolone are the systemic corticosteroids of choice during breastfeeding.

    Side Effects

    Abdominal distension
    Abscess (sterile)
    Acute pancreatitis
    Aggravation of schizophrenia
    Anaphylactoid reaction
    Aseptic necrosis
    Avascular osteonecrosis
    Behavioural disturbances
    Blurred vision
    Bowel perforation
    Cognitive impairment
    Congestive cardiac failure
    Corneal thinning
    Cushingoid facies
    Cutaneous atrophy
    Emotional lability
    Exacerbation of ophthalmic fungal disease
    Exacerbation of ophthalmic viral disease
    Gastro-intestinal haemorrhage
    Growth suppression in infancy, childhood and adolescence
    Hypersensitivity reactions
    Hypertrophic cardiomyopathy
    Hypokalaemic alkalosis
    Impaired carbohydrate tolerance, increased need for anti-diabetic therapy
    Impaired healing
    Increase in serum alkaline phosphatase (reversible)
    Increase in serum ALT/AST
    Increased appetite
    Increased I.C.P. with papilloedema in children (pseudotumour cerebri)
    Increased intra-ocular pressure
    Increased susceptibility to infection
    Increased sweating
    Kaposi's Sarcoma
    Laryngeal oedema
    Menstrual disturbances
    Muscle weakness
    Myocardial rupture
    Negative calcium balance
    Negative nitrogen balance
    Oesophageal candidiasis
    Oesophageal ulceration
    Opportunistic infections
    Peptic ulceration with perforation and haemorrhage
    Potassium loss
    Proximal myopathy with wasting and weakness
    Psychological dependence
    Pulmonary embolism
    Recurrence of dormant tuberculosis
    Scleral thinning
    Skin atrophy
    Skin pigmentation changes
    Sleep disturbances
    Sodium/water retention
    Subcutaneous atrophy
    Suicidal tendencies
    Suppression of clinical signs of infection
    Suppression of reactions to skin tests
    Suppression of the hypothalamic-pituitary-adrenal axis
    Tendon rupture
    Vertebral and long bone fractures
    Weight gain
    Withdrawal symptoms

    Withdrawal Symptoms and Signs

    Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death. A `withdrawal syndrome' may also occur including fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and weight loss.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last review date: November 2020

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Solu-Cortef. Pfizer Limited. Revised August 2020.

    NICE Evidence Services Available at: Last accessed: 18 November 2020

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